Supraventricular Bradycardia and AV Blocks - Revision history

Mfrdmanager at 13:39, 13 November 2020

2020-11-13T13:39:47Z

Mfrdmanager: Protected "Supraventricular Bradycardia and AV Blocks" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

2018-02-10T14:03:10Z

Protected "Supraventricular Bradycardia and AV Blocks" ([Edit=Allow only administrators] (indefinite) [Move=Allow only administrators] (indefinite))

Mfrdmanager: Created page with "==Section 4 - CARDIAC== ===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS=== INITIAL MEDICAL CARE (2.01) - OXYGEN..."

2018-02-10T14:03:05Z

Created page with "==Section 4 - CARDIAC== ===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS=== INITIAL MEDICAL CARE (2.01) - OXYGEN..."

New page

==Section 4 - CARDIAC==
===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS===

[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.

'''STABLE:'''
* For 2nd Degree, Type II or 3rd Degree Heart Block, Apply [[Transcutaneous Pacing Procedure|transcutaneous pacemaker]] (TCP) on stand-by mode.

'''UNSTABLE:'''
*Apply [[Transcutaneous Pacing Procedure|TCP]] on stand-by.
* [[Antiarrhythmics|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP
* If transient increase in heart rate noted and improved patient status, Repeat [[Antiarrhythmics|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.
* Initiate [[Transcutaneous Pacing Procedure|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.
* Consider administration of [[Sedative Hypnotics|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
* If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.
* 0.9% NaCl 200 - 300 ml fluid bolus.
* [[Adrenergics|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Antiarrhythmics|ATROPINE SULFATE]] and proceed directly to pacing.
* If drug induced, treat as per specific drug overdose.
** For calcium channel and beta blockers, administer [[Antidiabetics|GLUCAGON]] 2mg (may repeat x 1)
** For calcium channel blockers, administer [[Electrolytes|CALCIUM CHLORIDE]] 1 gram IVP. (Avoid if patient in on digoxin or lanoxin).
** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes|SODIUM BICARBONATE]], 1 mEq/kg IVP.
** For narcotic OD, administer [[Antagonists|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.

'''''DO NOT GIVE [[Antiarrhythmics|LIDOCAINE]] TO THESE RHYTHMS'''''

This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''

[[Category:Cardiac|0406]]

@@ Line 2: / Line 2: @@
 ===4.06 SUPRAVENTRICULAR BRADYCARDIA AND A.V. BLOCKS===
-[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask or assist with BVM.
+[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Oxygen|OXYGEN]] @ 100% via NRB mask or assist with BVM.
 '''STABLE:'''
@@ Line 9: / Line 9: @@
 '''UNSTABLE:'''
 *Apply [[Transcutaneous Pacing Procedure|TCP]] on stand-by.
-* [[Antiarrhythmics|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP
+* [[Atropine|ATROPINE SULFATE]] 0.5 - 1.0 mg rapid IVP
-* If transient increase in heart rate noted and improved patient status, Repeat [[Antiarrhythmics|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.
+* If transient increase in heart rate noted and improved patient status, Repeat [[Atropine|ATROPINE SULFATE]] as needed every 3 minutes to a total dose of 3.0 mg.
 * Initiate [[Transcutaneous Pacing Procedure|TCP]]. Pacemaker output may cause excessive pain / distress in the conscious patient.
-* Consider administration of [[Sedative Hypnotics|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
+* Consider administration of [[Versed|VERSED]] 2-5 mg initial dose then 2 mg every 30 seconds to 1 minute for conscious sedation.
 * If mechanical capture present and symptoms unresolved, increase TCP by 10 BPM until improvement noted or TCP set at 80 BPM.
 * 0.9% NaCl 200 - 300 ml fluid bolus.
-* [[Adrenergics|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
+* [[Dopamine|DOPAMINE]] 5 - 20 mcg / kg / minute titrated to systolic BP > 90 mm Hg.
-* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Antiarrhythmics|ATROPINE SULFATE]] and proceed directly to pacing.
+* If patient exhibits acute distress, as evidenced by AMS and / or presents with a 2nd Degree, Type II or 3rd degree Heart Block, bypass [[Atropine|ATROPINE SULFATE]] and proceed directly to pacing.
 * If drug induced, treat as per specific drug overdose.
-** For calcium channel and beta blockers, administer [[Antidiabetics|GLUCAGON]] 2mg (may repeat x 1)
+** For calcium channel and beta blockers, administer [[Glucagon|GLUCAGON]] 2mg (may repeat x 1)
-** For calcium channel blockers, administer [[Electrolytes|CALCIUM CHLORIDE]] 1 gram IVP.  (Avoid if patient in on digoxin or lanoxin).
+** For calcium channel blockers, administer [[Calcium Chloride|CALCIUM CHLORIDE]] 1 gram IVP.  (Avoid if patient in on digoxin or lanoxin).
-** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Electrolytes|SODIUM BICARBONATE]], 1 mEq/kg IVP.
+** For Tricyclic (i.e.: amitriptyline [Elavil], amoxapine, imipramine [Tofranil], nortriptyline [Pamelor]) and tetracyclic (i.e.: Remeron) antidepressants OD, with wide ORS > 0.10 sec, administer [[Sodium Bicarbonate|SODIUM BICARBONATE]], 1 mEq/kg IVP.
-** For narcotic OD, administer [[Antagonists|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.
+** For narcotic OD, administer [[Naloxone|NALOXONE (NARCAN)]] 0.4 mg IVP, IO or IN start low and titrate for respiratory function improvement. Maximum total dose of 2 mg.
-'''''DO NOT GIVE [[Antiarrhythmics|LIDOCAINE]] TO THESE RHYTHMS'''''
+'''''DO NOT GIVE [[Lidocaine|LIDOCAINE]] TO THESE RHYTHMS'''''
 This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''
 [[Category:Cardiac|0406]]

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